Central Serous What?
I think we’ve all learned what stress can do to us physically over the last few years. Everything from shingles to cardiovascular problems can be linked to stress and its effects on our bodies. The eyes are not exempt when it comes to this.
One of the manifestations of stress on the eyes is known as central serous chorioretinopathy (CSCR). While this ocular condition can be found in both men and women of all ethnic backgrounds, it is more commonly found in Caucasian males after the third decade of life. It affects about 10 men and 2 women per 100,000 people.
The more common risk factors include the systemic use of steroid-based medications ”type A” personalities, and pregnancy. Other risk factors include, but are not limited to testosterone medications, sleep apnea, and hypertension.
So, what exactly is central serous chorioretinopathy? It is an ocular condition that affects a specific part of the retina, known as the macula. The macula is responsible for the central 10 degrees of your visual field and your ability to see detail. The patient will usually notice some type of visual loss in the affected eye and may also report distortion of straight edges.
Upon examination, the eye doctor will usually observe a round detachment of the retina including the macular area. Fluid will collect under the detachment.
Further testing is usually warranted to confirm what is observed in gross examination. The doctor may order imaging studies that include having a dye injected into the bloodstream to better visualize the detachment as well as leakage in the retina. These tests are useful in not only making the correct diagnosis, but in determining if the condition is new or long-standing.
A study known as an OCT will often demonstrate a greater than average thickness of the tissue under the retina, known as the choroid, in CSCR. Most healthy patients will have a choroidal thickness of about 370 micrometers, while those with central serous chorioretinopathy will have a choroidal thickness of closer to 475 micrometers.
Most cases of CSCR resolve on their own with little to no permanent vision loss. Persistent cases can lead to permanent changes in the macular tissue; therefore, in cases lasting greater than four months, therapeutic options should be discussed with a retinal specialist.
The exact cause of central serous retinopathy is not fully understood. A recommended treatment has not yet been established, but a variety of therapies and behavior modifications have led to varying levels of resolution in this condition.
The oldest form of treatment is known as thermal photocoagulation with argon laser. This therapy is based on mechanically treating the detachment, which is thought to be the cause of the leakage in the retina. Treatment to this area can stop the active leakage and lead to faster resolution of the detachment; however, this laser also causes collateral damage to surrounding areas of the retina. It cannot be used over large areas of the retina or in areas that are too close to the macula. Laser treatment often leaves behind scar tissue which leads to loss of vision in those areas.
PDT laser therapy is based on the idea that the leakage is coming from the blood vessels in the layer of tissue under the retina (the choroid). This type of laser treatment is thought to cause a series of events leading to less congestion in the vessels. PDT is safer to use over larger areas of the retina and can be applied closer to the macula than argon laser. Availability and insurance coverage may present barriers to this treatment.
Topical medicated eye drops have also been studied as potential treatments in CSCR. Non-steroidal anti-inflammatory medications (NSAIDS) and carbonic anhydrase inhibitors (CAIs) have been used in various cases. NSAIDS seemed to increase fluid reabsorption in some; however, a possible placebo effect has been suggested, especially for those with a “type A” personality. CAIs have seemed to decrease the thickness of the macula at three months compared with control patients in other studies.
There is a wide array of responses to these treatments, and, as such, there is currently no standard of care in managing these patients. Therapy is usually individualized with many different considerations taken into account. Most cases will resolve on their own, without therapy, within 4-6 months.
If you notice any disturbance or loss of vision, please call your eye doctor today for an evaluation. If treatment is warranted, it is always better to start early than wait too long.